The Impact of Hip Arthroscopy on Long-term Performance Trajectories in NHL Players: A Matched Cohort Study Using Advanced Analytics

Background: Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain in elite athletes and frequently necessitates hip arthroscopy in National Hockey League (NHL) players. While high return-to-sport (RTS) rates are reported, the long-term impact of surgery on player performance using advanced analytics has not been well studied. Hypothesis: Players undergoing surgery would exhibit steeper performance declines in defensive performance metrics relative to matched controls, despite similar RTS rates. Study Design: Cohort study; Level of evidence, 3. Methods: This matched cohort study identified NHL skaters who underwent hip arthroscopy for FAIS between 2000 and 2024 using publicly available databases. Surgical confirmation was established through ≥2 independent sports news outlets. Players active for ≥2 seasons between 2007 and 2025 were matched 1:1 to controls based on position and performance at age 24. Outcomes included Wins Above Replacement per 60 minutes (WAR/60) and offensive and defensive Goals Above Replacement per 60 minutes (Off GAR/60, Def GAR/60), obtained from Evolving-Hockey. Fixed-effects panel regression with joint F tests was used to model longitudinal aging curves and isolate surgical effects from natural performance decline. Results: A total of 63 NHL skaters (42 forwards, 21 defensemen) were included and matched to controls. Among forwards, hip arthroscopy was associated with a statistically significant decline in Def GAR/60 across the aging curve (interaction P = .04), while Off GAR/60 (P = .64) and WAR/60 (P = .40) showed no significant differences. No statistically significant performance differences were observed among defensemen. Conclusion: This study demonstrated that hip arthroscopy was associated with a steeper age-related decline in defensive performance among NHL forwards, while offensive metrics and overall player value remained unaffected. No significant performance differences were noted in defensemen. Integrating surgical history into performance models may improve player evaluation and recovery strategies.